With aging in progress, the increase of the elderly with disorders and their care has become a serious regional problem. To step up regional care in an efficient manner, there is the need for well-organized activities with the involvement of all sorts of local people, such as medical workers (physicians, nurses, etc.), health workers (public health nurses, home helpers, medical social workers (MSW), etc.), volunteers and other people in the neighborhood in a system of coordination with various local institutions (hospitals, general practitioners' clinics, municipalities, welfare offices, social security councils, etc.) and facilities (homes for the elderly and health service facilities for the aged). Given this necessity, I have studied the efficient way in which a regional care system ought to be and the way we should wrestle with this issue in order to upgrade the delivery of regional careto old people with disorders.
In a system for the delivery of regional care, the first necessary step is to prepare a place for information and liaison among various regional institutions. In this study, it has become evident that local liaison meetings, round-table discussions and research meetings are enthusiastically held to produce significant effects. For studies on actual cases of regional care, welfare service teams for the elderly are organized, but it is necessary for them to involve field personnel, such as municipal officials, medical institution officials, murses on call, home helpers, volunteers, social security council officials, agricultural cooperative officials and workers at health service facilities fore the aged.
In the process of helping at-home care, the coordination of local medical institution workers, public health nurses and officials of welfare offices is particularly required. More than anything else, it is necessary for medical institutions to have an in-house division in charge of at-home care for the offer of over-the-counter services. Presumably, there are a wide variety of forms and methods for the creation of a local network. As each district has its own conditions and circumstances, the most efficient method should be worked out for each district.
With the aging of subject patients, there are sure signs of an increase in the delivery of care by nurses on call, and the responses have become all the more compolicated. The necessity of care by hospital nurses on call is greater than ever. On the other hand, there are many calls for a doctor's visit. Particularly in rural communities where enough physicians are not available, it is an urgent task to establish a system of home calls while coordinating with local general practitioners and sharing roles with them.
Health service facilities for the aged play a role in supplementing care at home, but those facilities which are not established side by side with hospitals have to render on-call services, whereas when it comes to hospitals without health service facilities for the aged, it is desirable for them to establish day care facilities. Attempts are already under way at various places to integrate health, medical and welfare facilities in one area so that high hopes may be pinned on significant effects both in terms of hardware and software. In this situation, it is necessary for medical institutions to play a significant role. It is necessary to step up support to the reversion to society of people given care at home and the training of volunteers as one of those medical institutions' principal roles.

Of all chronic pesticide poisoning (disorders), I reviewed nervous and mental disorders from a clinical and epidemiological point of view.
Exhibiting signs of a chronic course, nervous and mental disorders are classified into three types: delayed polyneuropathy, chronic sequelae following acute poisoning and poisoning (disorders) from a chronic exposure. Delayed polyneuropathy consists of extremital sensory disorders and motor paralysis which occur 2-4 weeks after the acute phase, and organophosphorous agents are responsible for them in many cases. The chronic sequelae following acute poisoning are something the symptoms of which persist for months or even for years after an acute exposure. Some of them primarily feature headaches and vision disorders, and central nervous system disorders, mental symptoms, psychic sequelae, and drops in the neuropsychiatric function, among others, are observed. Poisoning (disorders) from a chronic exposure results from an uninterrupted long-period exposure, and neurobehavioral effects, central and peripheral nervous disorders, Parkinson's disease, parkinsonism, dementia and mental disorders, among others, are observed.
I analyzed the clinical features of nervous and mental disorders and at the same time studied methods for clinical diagnosis.

Of all chronic pesticide poisoning (disorders), this is an attempt to review pulmo-bronchial disorders, hepatic disorders, stomach disorders, blood and hematopoietic disorders, hypertension and vascular disorders, dysbolism and immunological disorders in a clinical and epidemiological perspective.
The pulmo-bronchial disorders consist mostly of those with pneumonic episodes and chronic progressive lung fibrosis. Then there were asthma, chronic bronchitis and degenerated hepatic functions, among others. The prevalence of hepatic disorders was high among persons exposed to pesticides, and they were caused by organochlorine and TCDD. Then there were cases with hepatic cirrhosis because of a continued intake of arsenic, a residue in the wine. When it comes to stomach disorders, some were caused by a sustained exposure to organophosphate and sustained intakes from vegetables. In regard to blood and hematopoietic disorders, many cases with apalastic anemia caused by PCP and other blood diseases were observed. As for vascular disorders, cases with arteriosclerotic episodes by paraquat, whereas cases with porphyria by HCB and hyperlipemia by organochlorine. Then there were cases with immunological abnormalities by organochlorine, organophosphate and carbamate.
As many pesticides are mucocutaneously stimulative and allergic in addition to their own toxicity, there is a need to give thought to their compound effects when it comes to disorders to human bodies.

We have studied the degree to which health screenings and health education activities, including health promotion and improvements in the lifestyle, are contributory to the reduction of outlays for disease prevention and medical care.
An analysis of all municipalities in one prefecture reveals that the larger the number of public health nurses and the rate of undergoing a health checkup, the smaller the expenses required for inpatient and outpatient services. In a comparison between the municipalities where adequate health screenings and health education are provided and those in which no such activities are evolved yet in another prefecture, the outlays necessary for the medical care of seniors are significantly lower in the former.
An analysis of Rezept, or the monthly bills for medical treatment forwarded by hospitals to the associations that take charge of the National Health Insurance Scheme, shows that the coverage of per-capita costs under the scheme for the treatment of people who undergo a health screening on a regular basis is lower than that of those who do not do so, despite the fact that the latter more often undergo treatment at medical institutions after they suffer from some kind of disease or the other. In a comparison of municipalities that differ in terms of the per-capita share in the coverage of the scheme, the lower the medical outlay, the higher the rate of undergoing a health screening, that of receiving treatment at local hospitals and that of deaths at home.
An analysis of persons who have regularly undergone a health checkup over a period of five years indicates that the improvements made in the everyday lifestyle, and in dietary practices, exercises and calisthenics are more significant than is the case with people who have not undergone it. In stomach cancer screenings (mass X-ray stomach screenings or endoscopy), the rate of deaths from cancer and the outlay for inpatient services are lower than those of people who have not undergone a health-checkup. When outlays for health screenings, those for inpatient services and a deathderived losses in the benefit are all taken into account, it follows that the benefit is higher for people who have undergone a health screening on a regular basis.

We have carried out mass health screenig projects and health-related educational programs including those for health promotion and lifestyle improvements. The purpose of this study was to clarify how instrumental those activities are in preventing disease and cutting down outlays for medical care. The findings are as follows:
1. In an analysis of the costs shared by all municipalities in Kumamoto Prefecture under the National Health Insurance Scheme (NHIS), the larger the number of public health nurses and the higher the response rate of the basic health screening, the lower the various outlays for health care of seniors and others.
2. In the municipalities where activities for health care are briskly evolved, the percapita outlay for medical care under the NHIS is low-significantly low for the medical care of seniors, in particular-and the drop in the outlay for medical care is large as against the cost involved in health screening. Conversely, in the municipalities where the per-capital expenditure for medical care under the NHIS was low, the activities for health screening and health-related education were brisk.
3. In an analysis of Rezept, or bills for medical care, the higher the willingness to undergo a health screening, the lower the expenditure for medical care under the NHIS. This holds true particularly of the NHIS expenditure for the medical care of inpatients.
4. Gastric mass screenig is instrumental in reducing the mortality rate of stomach cancer. Its cost-effectiveness could be ascertained when the lost profit was included.
5. Mass health screening was not directly tied in with a drop in the morbidity prevalence rate, but it was found instrumental in improving everyday life practices.

As regards the chronic disorders brought about by pesticides to human bodies, attempts have been made to review theses that have been published both at home and abroad in the last several years on the basis of epidemiological studies. The chronic disorders that are found to have something to do with pesticides are neurological disorders (Parkinson's disease, peripheral nervous symptoms, poor coordinations and abnormal deep tendon reflexes), mental disorders (mild cognitive dysfunction and neurosis), pulmonary and bronchial disorders, hematopietic disorders (aplastic anemia), thyroid disorders, ocular disorders, immune disorders, natal disorders and birth defects (teratism, spontaneous abortion, complete transposition of the great arteries and cryptorchism), disorders in childhood growth (disorders in social development and attention deficit disorders, among others), genital disorders (reduction in fertility, erectile dysfunction (ED) and oligozoospermia), oncogenesis and carcinogenesis (childhood cancer, leukemia, non-Hodgkin lymphoma, multiple myeloma, others and pulmonary, mammary, cystic, pancreatic, and prostatic cancers).The findings of epidemiological studies do not necessarily produce casual relationships but, as identical findings have come out in many epidemiological studies, it may be argued that they produce findings the casual relationship of which is considerably suspicious. The working of pesticides as chemicals to stir incretion (the working similar to that of estrogen), the working of dioxin contained as a byproduct and the impairment of DNA have something to do with causes to chronic disorders.With not only acute poisoning by pesticides but also chronic disorders, the greatest adverse impacts fall on farmers who are directly engaged in the spraying of pesticides. When it comes to genital disorders, birth defects and tumorigenesis, among others, the spraying of insecticides and the extermination of white ants in and out of the houses ought to be taken into full account.
seconds ; Pesticides ; Chronic Disease ; findings ; epidemiologic

Hepatitis B antigen and antibody were examined on 1, 984 adults in a village;for antigen with immune adherence hemagglutination method and for antibody with passive hemagglutionation method. Antigen were detected for 25 and antibody for 398 sera.The prevalence of 1.3 per cent for the antigen with this method is lower than that suspected from blood donors in Tokyo. Higher frequency was found in male, and in youth.In elderly persons, however, rather high prevalence was found than suspected before.

Part of the blood samples collected during group medical examinations might possibly be used as tumor markers a in preliminary screening for cancer. However, at the present, it would be too hasty a conclusion that the tumor markers in the blood samples are definitely effective in terms of practicality. There is much more probing yet to be done.
To begin with, the authors think it necessary to examine the normal values and basal ranges of tumor markers currently available and compare them with clinical values according to the types of cancer.
In this report, the five tumor markers (CEA, AFP, Ferritin, SCC and CA19-9) are dealt with. All these markers are undergoing clinical testing on patients in our hospital. The results so far obtained showed that each marker has its own characteristics. CEA has proved to be helpful in making the diagnosis of advanced colo-rectal carcinoma; AEP is useful for liver cancer; Ferritin, liver and lung cancers; SCC, squamous cell, carcinoma; CA19-9, cancer of the pancreas. However, to be noted is the fact that the cancer specificity of these markers are not alway high. Therefore, due caution should be exercised in the use of any one of the markers for cancer screening.
In the light of the fact that a combination assay of AFP and Ferritin is effective in diagnosis of primary hepatocellular carcinoma, combinations of dif-ferent markers are worth studying. Furthermore, the finding of blood tests and urianalyses should be checked against the measurements of markers. These efforts will certainly open up a new vista for more effective imple mentation of group cancer screening programs

The authors reviewed the English language papers concerning chronic health effects of agricultural chemicals, focusing on the incidence of cancer in pesticide users. These papers were collected using MEDLINE between 1988 and 1998 as a referencetool. According to the standard study design, the epidemiological literature is classified into cohort studies and case-control studies. These studies suggested the association between pesticides and various types of cancer such as soft tissue sarcoma, non-Hodgkin's lymphoma, lung cancer, and breast cancer. Categories of pesticides included in these studies, varied greatly, including herbicides and insecticides.
In this paper, we discussed about such problems as the selection of control groups and the assessment of pesticide exposure levels, which may pose some problems in conducting epidemiological research on the relationship between pesticides and cancer.
A model for a method of epidemiological study of health hazards due to pesticide exposure was also presented.